Safer Care of the Mechanically Ventilated Patient

Size: px
Start display at page:

Download "Safer Care of the Mechanically Ventilated Patient"

Transcription

1 Middle East Forum on Quality and Safety in Healthcare Collaborating for Excellence in Patient Care May 2015 QNCC, Doha, Qatar Safer Care of the Mechanically Ventilated Patient

2 Dr. Bill Andrews Deputy Chair for Quality, Department of Anesthesia, ICU and Perioperative Medicine Hamad Medical Corporation Corazu M. Salta BSN RN Quality Lead Coordinator (A) Surgical Intensive Care Unit Hamad General Hospital

3 We have no conflicts of interest

4 Have you observed the changes in the Health Care? Restraint Sedation Mobility Delirium

5 Who is more Vulnerable?

6 How can we keep our Patients Safe while they are on a Mechanical Ventilator?

7 What makes Mechanically Ventilated Patient Most Vulnerable? 1. Immobility 2. Invasion 3. Interstitial Edema 4. Injury 5. Immunosuppression 6. Infections 7. Insanity 8. Impaired Circulation

8 Dr. Bill Andrews

9 Ventilated Patients are Vulnerable!

10

11 Immobilization - Causes

12 Immobilization - Effects

13 Invasion - Causes

14 Invasion - Effects

15 Interstitial Edema - Causes

16 Interstitial Edema - Effects

17 Impaired Circulation - Causes

18 Impaired Circulation - Effects

19 Immunosuppression - Causes

20 Immunosuppression - Effects

21 Infection - Causes

22 Infection - Effects

23 Insanity (Delirium) - Causes

24 Insanity (Delirium) - Effects

25 Injury (Lung) - Causes

26 Injury (Lung) - Effects

27 Corazu M. Salta BSN.RN

28 Early Rehabilitation in the John Hopkins Hospital Dr. Dale Needham

29

30

31 What We Assume Sometimes is Totally the Opposite of What our Patient Really Feels.

32

33 Why Bundles? 5-3evidence based interventions Each with evidence that outcomes improve When done together, proven to improve outcomes* Synergy? *Resar R, Pronovost P, Haraden C, Simmonds T, et al. Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Joint Commission Journal on Quality and Patient Safety :)5(31;2005

34 Traditional Bundle Head of the bed 30 O Daily sedative interruption and daily assessment of readiness to extubate Daily oral care with chlorhexidine PUD prophylaxis DVT prophylaxis

35 Next Gen. Bundle - Awaken - Breathing (Allow Spontaneous) - Coordinate Awakening and Breathing - Delirium (Prevent, Detect and Manage) - Exercise and Promote Mobility

36 Dr. Bill Andrews

37 Vol 371 January 12, 2008

38 Vol 371 January 12, 2008

39 American Journal of Respiratory and Critical Care Medicine Volume 191 Number 3 February

40

41 Which sedative? Dexmedetomidine vs.midazolam? JAMA Feb 4;301(5):

42 JAMA Feb 4;301(5):

43 Long-term Cognitive and Psychological Outcomes in the Awakening and Breathing Controlled Trial Jackson Am J Respir Crit Care Med Vol 182. pp , 2010 Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial. Mehta JAMA Nov 21;308(19): A randomized trial of protocol-directed sedation management for mechanical ventilation in an Australian intensive care unit. Bucknall Crit Care Med May;36(5):

44 No Sedation? Lancet Feb 6;375(9713):

45 Is Anything NEW Under the Sun? What else can we do to keep our ventilated patients safe??

46 Not much? in What s New? Probiotic prophylaxis to prevent ventilator associated pneumonia (VAP) in children on mechanical ventilation: an open-label randomized controlled trial. Randomized controlled study of probiotics containing Lactobacillus casei (Shirota strain) for prevention of ventilator-associated pneumonia. Significant reduction in ventilator-associated pneumonia with the Venner-PneuX System in high-risk patients undergoing cardiac surgery: the Low Ventilator-Associated- Pneumonia study. Randomized intubation with polyurethane or conical cuffs to prevent pneumonia in ventilated patients. The preventability of ventilator-associated events. The CDC Prevention Epicenters Wake Up and Breathe Collaborative. The impact of abdominal massage administered to intubated and enterally fed patients on the development of ventilator-associated pneumonia: a randomized controlled study. Prevention of ventilator-associated pneumonia and ventilator-associated conditions: a randomized controlled trial with subglottic secretion suctioning.

47 Intensive Care Med (2015) 41:

48 Randomized controlled study of probiotics containing Lactobacillus casei (Shirota strain) for prevention of ventilatorassociated pneumonia. The incidence rates of VAP in the probiotics and control groups were and episodes per 1,000 ventilator-days, respectively (p =.) 0.37 J Med Assoc Thai Mar;98(3):

49 Subglottic suction Low pressure, low volume cuff, no creases Self adjusting tracheal seal monitor Non stick lining S. Gopal et al. / European Journal of Cardio-Thoracic Surgery

50 Subglottic suction Low pressure, low volume cuff, no creases Self adjusting tracheal seal monitor Non stick lining S. Gopal et al. / European Journal of Cardio-Thoracic Surgery

51 Colonization Risk Factors Antibiotic therapy at inclusion HR=0.76 p=0.002 Type of cuff HR=1.0 p=0.6 American Journal of Respiratory and Critical Care Medicine Volume 191 Number 6 March

52 The impact of abdominal massage administered to intubated and enterally fed patients on the development of ventilator-associated pneumonia: a randomized controlled study. Twice daily 15 minute abdominal massages Reduced gastric residual volumes (p<0.05) Reduced abdominal circumference Ventilator associated pneumonia reduced from 31.3% to 6.3% (NS) Int J Nurs Stud Feb;52(2):

53 Crit Care Med 2015; 43:22 30

54 Other Individual Strategies Intermittent sedation Fluid management Avoiding restraints Avoiding unnecessary respiratory support Subglottic suction Better airway care Cuff pressure control, no routine circuit changes Selective Digestive Decontamination Short course prophylactic antibiotic Hand hygiene

55 Corazu M. Salta BSN.RN

56 Time for a new Bundle?

57 Guidelines for the prevention of ventilatorassociated pneumonia and their implementation. The Spanish "Zero-VAP" bundle. They considered 35 potential prevention measures Med Intensiva May;38(4):

58 1. Semi-recumbent position 2. Strict hand hygiene with alcohol-based gels or solutions before airway management 3. Education and training in aspiration of bronchial secretions 4. Daily sedation vacation and assessment of weaning and extubation 5. Availability of weaning protocols 6. Early tracheostomy 7. Non-invasive mechanical ventilation 8. Microbiological surveillance of crosscontamination and infection 9. Instillation of normal saline prior to endotracheal suctioning 10. Ventilator tubing change 11. Route of endotracheal intubation. Orotracheal vs. nasotracheal 15 Elements 12. Type of airway humidification. Preference of heat moisture exchanger or heated humidifier 13. Physiotherapy 14. Positive end-expiratory airway pressure (PEEP) of 5 8cmH2O vs. Zero end-expiratory pressure (ZEEP) in patients without lung injury 15. Enteral feeding: route of administration and gastric residual volumes. Use of Prokinetics

59 1. Endotracheal tube cuff pressure monitoring 2. Subglottic secretion drainage 3. Polyurethane-cuffed endotracheal tubes 4. Polyurethane-cuffed endotracheal tubes with subglottic secretion drainage 5. Silver-coated endotracheal tubes 6. High-volume, low-pressure endotracheal tube cuff 7. Small caliber feeding tubes 8. Aspiration of tracheobronchial secretions with closed vs. open systems 9. Endotracheal tube biofilm removal 13 Elements device (Mucus Shaver ) 10. Kinetic bed therapy 11. Airway filters 12. Water-soluble gel lubrication of the endotracheal tube 13. Tooth brushing

60 . 1 Selective decontamination of the digestive tract. 2 Selective oropharyngeal decontamination. 3 Short course of intravenous antibiotic. 4 Oral hygiene with chlorhexidine. 5 Nebulized antibiotics. 6 Antibiotic cycling. 7 Probiotics 7 Elements

61 Med Intensiva May;38(4):

62 Now it s YOUR Turn! 15 minutes to do what the Spanish took months to do! Rate each intervention on a 1-5 scale for: Effectiveness, Safety, Feasibility, Cost We don t have real data, so we are going to be creative Choose 4-5 of the highest priority interventions

63 Dr. Bill Andrews

64 Spanish Results 153 Med Intensiva May;38(4):

65 Spanish Results 153 Med Intensiva May;38(4):

66 Spanish Results 153 Med Intensiva May;38(4):

67 Spanish Results 153 Med Intensiva May;38(4):

68 Spanish Results Med Intensiva May;38(4):

69 Spanish Results Med Intensiva May;38(4):

70 Spanish Results Med Intensiva May;38(4):

71 Spanish Results Med Intensiva May;38(4):

72 Spanish Results Med Intensiva May;38(4):

73 Spanish Results Med Intensiva May;38(4):

74 Spanish Results Med Intensiva May;38(4):

75 Spanish Results Med Intensiva May;38(4):

76 Summary 1. Immobility 2. Invasion 3. Interstitial Edema 4. Injury 5. Immunosuppression 6. Infections 7. Insanity 8. Impaired Circulation

77 Summary we can do better

78 How? - Awaken - Breathing (Allow Spontaneous) - Coordinate Awakening and Breathing - Delirium (Prevent, Detect and Manage) - Exercise and Promote Mobility And more...

79 It has been our pleasure! Thank you all

High Impact Intervention Care bundle to reduce ventilation-association pneumonia

High Impact Intervention Care bundle to reduce ventilation-association pneumonia High Impact Intervention Care bundle to reduce ventilation-association pneumonia Aim To reduce the incidence of ventilation-associated pneumonia (VAP). Context The aim of the care bundle, as set out in

More information

TRACHEOSTOMY TUBE PARTS

TRACHEOSTOMY TUBE PARTS Page1 NR 33 TRACHEOSTOMY CARE AND SUCTIONING Review ATI Basic skills videos: Tracheostomy care and Endotracheal suction using a closed suction set. TRACHEOSTOMY TUBE PARTS Match the numbers on the diagram

More information

1.40 Prevention of Nosocomial Pneumonia

1.40 Prevention of Nosocomial Pneumonia 1.40 Purpose Audience Policy Statement: The guideline is designed to reduce the incidence of pneumonia and other acute lower respiratory tract infections. All UTMB healthcare workers and contract healthcare

More information

Appendix A Recommendations and guidelines of the CDC and Institute for Healthcare Improvement

Appendix A Recommendations and guidelines of the CDC and Institute for Healthcare Improvement Guidelines For CDC recommendations, Category 1 recommendations are in bold. CDC Central Line Insertion Practices (CLIP) Adherence Monitoring Hand hygiene performed Appropriate skin prep o Chlorhexidene

More information

NURSING SERVICES DEPARTMENT

NURSING SERVICES DEPARTMENT NURSING SERVICES DEPARTMENT TITLE: Mechanical Ventilation PATIENT CARE PLAN DIAGNOSIS: DISCHARGE CRITERIA: 1 The patient will: Maintain adequate mechanics of PERTINENT INFORMATION:. ventilation as demonstrated

More information

Ki m b e r l y-cl a r k* 72-Hour Closed-Suction Systems. Ba l l a r d* Tr a c h Ca r e* System. A unique design. A new standard in clean.

Ki m b e r l y-cl a r k* 72-Hour Closed-Suction Systems. Ba l l a r d* Tr a c h Ca r e* System. A unique design. A new standard in clean. Ki m b e r l y-cl a r k* 72-Hour Closed-Suction Systems Ba l l a r d* Tr a c h Ca r e* System A unique design. A new standard in clean. Ki m b e r l y-cl a r k* 72-Hour Closed-Suction Systems Ba l l a

More information

Joint Theater Trauma System Clinical Practice Guideline

Joint Theater Trauma System Clinical Practice Guideline Page 1 of 8 VENTILATOR ASSOCIATED PNEUMONIA Original Release/Approval 09 Nov 2007 Note: This CPG requires an annual review. Reviewed: Jun 2012 Approved: 17 Jul 2012 Supersedes:, 1 Mar 2010 Minor Changes

More information

Nurses Competencies in Caring for Mechanically Ventilated Patients, What does the Evidence Say? Dr. Samah Anwar Dr. Noha El-Baz

Nurses Competencies in Caring for Mechanically Ventilated Patients, What does the Evidence Say? Dr. Samah Anwar Dr. Noha El-Baz Nurses Competencies in Caring for Mechanically Ventilated Patients, What does the Evidence Say? Dr. Samah Anwar Dr. Noha El-Baz The mechanically ventilated patient presents many challenges for the intensive

More information

Guidelines for Standards of Care for Patients with Acute Respiratory Failure on Mechanical Ventilatory Support

Guidelines for Standards of Care for Patients with Acute Respiratory Failure on Mechanical Ventilatory Support Guidelines for Standards of Care for Patients with Acute Respiratory Failure on Mechanical Ventilatory Support Copyright by the SOCIETY OF CRITICAL CARE MEDICINE These guidelines can also be found in the

More information

Virginia Office of Emergency Medical Services Scope of Practice - Procedures for EMS Personnel

Virginia Office of Emergency Medical Services Scope of Practice - Procedures for EMS Personnel Specific tasks in this document shall refer to the Virginia Education Standards. AIRWAY TECHNIQUES Airway Adjuncts Airway Maneuvers Alternate Airway Devices Cricothyrotomy Obstructed Airway Clearance Intubation

More information

Tracy Johns, RN, BSN, CPHQ Medical Center of Central Georgia

Tracy Johns, RN, BSN, CPHQ Medical Center of Central Georgia Tracy Johns, RN, BSN, CPHQ Medical Center of Central Georgia NDNQI Quality Conference: February 2013 2 637 bed, acute-care academic medical center 2 nd largest hospital in Georgia Magnet designation 2005

More information

Hospital of the University of Pennsylvania Physician Practice Guideline

Hospital of the University of Pennsylvania Physician Practice Guideline Page 1 of 5 KEY WORDS: Ventilator Respirator Weaning Extubation Liberation PURPOSE: To facilitate the liberation of patients from mechanical ventilation and provide a consistent approach to the ventilator

More information

Designed by the Gravity-VAP Network

Designed by the Gravity-VAP Network Prospective, Randomized, Multi-Center Trial of Lateral Trendelenburg Versus Semi-Recumbent Body Position in Mechanically Ventilated Patients For The Prevention of Ventilator-Associated Pneumonia Designed

More information

Management of airway burns and inhalation injury PAEDIATRIC

Management of airway burns and inhalation injury PAEDIATRIC Management of airway burns and inhalation injury PAEDIATRIC A multidisciplinary team should provide the management of the child with inhalation injury. Childhood inhalation injury mandates transfer to

More information

THE EFFECTS OF NURSE EDUCATION AND CERTIFICATION ON HOSPITAL- ACQUIRED INFECTIONS

THE EFFECTS OF NURSE EDUCATION AND CERTIFICATION ON HOSPITAL- ACQUIRED INFECTIONS THE EFFECTS OF NURSE EDUCATION AND CERTIFICATION ON HOSPITAL- ACQUIRED INFECTIONS Cassi Welch, BSN Honors Student Faculty Mentor: Emily Cramer, PhD Submitted to the University of Kansas School of Nursing

More information

Nursing college, Second stage Microbiology Dr.Nada Khazal K. Hendi L14: Hospital acquired infection, nosocomial infection

Nursing college, Second stage Microbiology Dr.Nada Khazal K. Hendi L14: Hospital acquired infection, nosocomial infection L14: Hospital acquired infection, nosocomial infection Definition A hospital acquired infection, also called a nosocomial infection, is an infection that first appears between 48 hours and four days after

More information

Translating Evidence to Safer Care Patient Safety Research Introductory Course Session 7 Albert W Wu, MD, MPH Former Senior Adviser, WHO Professor of Health Policy & Management, Johns Hopkins Bloomberg

More information

Levels of Critical Care for Adult Patients

Levels of Critical Care for Adult Patients LEVELS OF CARE 1 Levels of Critical Care for Adult Patients STANDARDS AND GUIDELINES LEVELS OF CARE 2 Intensive Care Society 2009 All rights reserved. No reproduction, copy or transmission of this publication

More information

Iatrogenesis. Suzanne Beyea,, RN, PhD, FAAN Associate Director: Centers for Health and Aging

Iatrogenesis. Suzanne Beyea,, RN, PhD, FAAN Associate Director: Centers for Health and Aging Iatrogenesis Suzanne Beyea,, RN, PhD, FAAN Associate Director: Centers for Health and Aging Iatrogenesis Definition from the Greek word, iatros,, meaning healer, iatrogenesis means brought forth by a healer

More information

endotracheal tube guide We provide Rusch quality.

endotracheal tube guide We provide Rusch quality. endotracheal tube guide We provide Rusch quality. 2 RUSCH ENDOTRACHEAL TUBE GUIDE RUSCH ENDOTRACHEAL TUBE GUIDE 3 subglottic secretion removal a vap reduction strategy Ventilator-Associated Pneumonia (VAP)

More information

Colorado Cardiac Conference: 2 nd teaching workshop. Proactive Respiratory Therapy in postoperative Cardiac Patients

Colorado Cardiac Conference: 2 nd teaching workshop. Proactive Respiratory Therapy in postoperative Cardiac Patients Colorado Cardiac Conference: 2 nd teaching workshop Proactive Respiratory Therapy in postoperative Financial Disclosures Donald Fritz, RT Jerrold Judd, RT No relevant financial relationships with any commercial

More information

Place hospital logo here

Place hospital logo here Place hospital logo here Massachusetts General Hospital (MGH) Collaborate to Extubate: A Needs Assessment and Educational Program on the ABCDEF Bundle Erica Edwards, RN, MSN, CCRN-CMC, CHFN Lisa O Neill,

More information

Health care associated

Health care associated Feature Using Evidence-Based Practice to Prevent Ventilator- Associated Pneumonia Mary Beth Sedwick, RN, BSN, MS, CCRN Mary Lance-Smith, RN, MSN, CCRN Sara J. Reeder, RN, PhD Jessica Nardi, RN, BSN, CCRN

More information

Recommendations: Other Supportive Therapy of Severe Sepsis*

Recommendations: Other Supportive Therapy of Severe Sepsis* Recommendations: Other Supportive Therapy of Severe Sepsis* K. Blood Product Administration 1. Once tissue hypoperfusion has resolved and in the absence of extenuating circumstances, such as myocardial

More information

5/29/2014. Infection Control in the NICU. Objectives. The Babies. Terrence Shenfield BS RRT/RPFT/NPS Education Coordinator University Hospital

5/29/2014. Infection Control in the NICU. Objectives. The Babies. Terrence Shenfield BS RRT/RPFT/NPS Education Coordinator University Hospital Infection Control in the NICU Terrence Shenfield BS RRT/RPFT/NPS Education Coordinator University Hospital Objectives Discuss nosocomial infections in the NICU Device acquired infections Ventilator Associated

More information

This is a time of heightened national

This is a time of heightened national By Martha A. Q. Curley, PhD, RN, FAAN, and Patricia A. Hickey, MS, MBA, RN, CNAA The Nightingale Metrics Nurses at one institution improved outcomes by putting patients in the best condition for nature

More information

convey the clinical quality measure's title, number, owner/developer and contact

convey the clinical quality measure's title, number, owner/developer and contact CMS-0033-P 153 convey the clinical quality measure's title, number, owner/developer and contact information, and a link to existing electronic specifications where applicable. TABLE 20: Proposed Clinical

More information

LESSON 4 ORAL, NASOPHARYNGEAL, AND NASOTRACHEAL SUCTIONING.

LESSON 4 ORAL, NASOPHARYNGEAL, AND NASOTRACHEAL SUCTIONING. LESSON 4 ORAL, NASOPHARYNGEAL, AND NASOTRACHEAL SUCTIONING. 4-1. SUCTIONING a. Suctioning is a common nursing activity performed for the purpose of removing accumulated secretions from the patient's nose,

More information

2015 SUMMER STUDENT NURSE EXTERNSHIP PROGRAM SKILLS CHECK LIST

2015 SUMMER STUDENT NURSE EXTERNSHIP PROGRAM SKILLS CHECK LIST 2015 SUMMER STUDENT NURSE EXTERNSHIP PROGRAM SKILLS CHECK LIST STUDENT NURSE EXTERNNAME SCHOOL OF NURSING STUDENT AGREEMENT: I request the Clinical Skills Check list be released to (hospital/agency). I

More information

Prevention of Ventilator-Associated Pneumonia

Prevention of Ventilator-Associated Pneumonia Health Care Protocol: Fifth Edition November 2011 The information contained in this ICSI Health Care Protocol is intended primarily for health professionals and the following expert audiences: physicians,

More information

Therapist Multiple-Choice Examination

Therapist Multiple-Choice Examination Therapist Multiple-Choice Examination Effective: January 2015 Detailed Content Outline Items are linked to open cells. Each scored form will include 20-item pretests. I. PATIENT DATA EVALUATION AND RECOMMENDATIONS

More information

Catheter-Associated Urinary Tract Infection (CAUTI) Prevention. Basics of Infection Prevention 2 Day Mini-Course 2013

Catheter-Associated Urinary Tract Infection (CAUTI) Prevention. Basics of Infection Prevention 2 Day Mini-Course 2013 Catheter-Associated Urinary Tract Infection (CAUTI) Prevention Basics of Infection Prevention 2 Day Mini-Course 2013 2 Objectives Define the scope of healthcare-associated urinary tract infections (UTI)

More information

Nursing Quality: Measurement and Improvement

Nursing Quality: Measurement and Improvement Nursing Quality: Measurement and Improvement This self-directed learning module contains information you are expected to know to protect yourself, our patients, and our guests. Target Audience: CMC and

More information

DRAFT 7/17/07. Procedural Sedation and Rapid Sequence Intubation (RSI) Consensus Statement

DRAFT 7/17/07. Procedural Sedation and Rapid Sequence Intubation (RSI) Consensus Statement Procedural Sedation and Rapid Sequence Intubation (RSI) Consensus Statement Many patients with emergency medical conditions in emergency and critical care settings frequently experience treatable pain,

More information

How To Determine The Number Of Respiratory Therapists

How To Determine The Number Of Respiratory Therapists AARC White Paper November 8, 2012 BEST PRACTICES IN RESPIRATORY CARE PRODUCTIVITY AND STAFFING This paper provides guidance and considerations in the application of the AARC Position Statement: Best Practices

More information

81 First Responder Respiratory

81 First Responder Respiratory 81 First Responder Medical Scenarios Asthma Scenario: You are called to a local house for a woman with trouble breathing. You arrive to find a 67-year-old woman sitting upright in a chair. She states she

More information

Chronic Critical Illness: Can it be prevented? Carmen C Polito, MD Pulmonary & Critical Care Medicine Emory University Atlanta, GA cpolito@emory.

Chronic Critical Illness: Can it be prevented? Carmen C Polito, MD Pulmonary & Critical Care Medicine Emory University Atlanta, GA cpolito@emory. Chronic Critical Illness: Can it be prevented? Carmen C Polito, MD Pulmonary & Critical Care Medicine Emory University Atlanta, GA cpolito@emory.edu Data free zone Disclosures A (Very) Old Case 65 year-old

More information

Weaning the Unweanable

Weaning the Unweanable Weaning the Unweanable Gerald W. Staton, Jr, MD Professor of Medicine Pulmonary & Critical Care Medicine Emory University School of Medicine Atlanta, GA gerald.staton@emory.edu Disclosures Pulmonary Program

More information

Importance of Protocols in the Decision to Use Noninvasive Ventilation

Importance of Protocols in the Decision to Use Noninvasive Ventilation Importance of Protocols in the Decision to Use Noninvasive Ventilation Janice L. Zimmerman, M.D. Weill Cornell Medical College The Methodist Hospital Houston, Texas Objectives Review application of protocols

More information

Emergency Medical Services Advanced Level Competency Checklist

Emergency Medical Services Advanced Level Competency Checklist Emergency Services Advanced Level Competency Checklist EMS Service: Current License in State of Nebraska: # (Copy of license kept in file at station) Date of joining EMS Service: EMS Service Member Name:

More information

Ventilator-Associated Pneumonia: Prevention and Diagnosis

Ventilator-Associated Pneumonia: Prevention and Diagnosis Ventilator-Associated Pneumonia: Prevention and Diagnosis Kathleen Stoessel, RN, BSN, MS Senior Manager, Clinical Education Kimberly-Clark Health Care September 2011 1 1 VAP: Prevention and Diagnosis Objectives

More information

INTERDISCIPLINARY CLINICAL MANUAL Policy/ Procedure

INTERDISCIPLINARY CLINICAL MANUAL Policy/ Procedure INTERDISCIPLINARY CLINICAL MANUAL Policy/ Procedure TITLE: Non Invasive Positive NUMBER: CC 45-072 Pressure Ventilation Date Issued: October 2011 Page 1 of 13 Applies To: Respiratory Therapy and Nursing

More information

Airway Pressure Release Ventilation

Airway Pressure Release Ventilation Page: 1 Policy #: 25.01.153 Issued: 4-1-2006 Reviewed/ Revised: Section: 10-11-2006 Respiratory Care Airway Pressure Release Ventilation Description/Definition Airway Pressure Release Ventilation (APRV)

More information

5/30/2014 OBJECTIVES THE ROLE OF A RESPIRATORY THERAPIST IN THE DELIVERY ROOM. Disclosure

5/30/2014 OBJECTIVES THE ROLE OF A RESPIRATORY THERAPIST IN THE DELIVERY ROOM. Disclosure THE ROLE OF A RESPIRATORY THERAPIST IN THE DELIVERY ROOM Ona Fofah, MD FAAP Assistant Professor of Pediatrics Director, Division of Neonatology Department of Pediatrics Rutgers- NJMS, Newark OBJECTIVES

More information

3100B Clinical Training Program. 3100B HFOV VIASYS Healthcare

3100B Clinical Training Program. 3100B HFOV VIASYS Healthcare 3100B Clinical Training Program 3100B HFOV VIASYS Healthcare HFOV at Alveolar Level Nieman,, G, SUNY 1999 Who DO We Treat? Only Pathology studied to date has been ARDS Questions about management of adults

More information

GUIDELINES FOR THE MANAGEMENT OF OXYGEN THERAPY

GUIDELINES FOR THE MANAGEMENT OF OXYGEN THERAPY SOUTH DURHAM HEALTH CARE NHS TRUST GUIDELINES FOR THE MANAGEMENT OF OXYGEN THERAPY AIM To supplement oxygen intake using the appropriate equipment in order to correct hypoxia and relieve breathlessness.

More information

Perioperative Management of Patients with Obstructive Sleep Apnea. Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine

Perioperative Management of Patients with Obstructive Sleep Apnea. Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine Perioperative Management of Patients with Obstructive Sleep Apnea Kalpesh Ganatra,MD Diplomate, American Board of Sleep Medicine Disclosures. This activity is supported by an education grant from Trivalley

More information

Application of the Passy-Muir Swallowing and Speaking Valves Julie A. Kobak Director of Clinical Education-Speech jkobak@passy-muir.

Application of the Passy-Muir Swallowing and Speaking Valves Julie A. Kobak Director of Clinical Education-Speech jkobak@passy-muir. Application of the Passy-Muir Swallowing and Speaking Valves Julie A. Kobak Director of Clinical Education-Speech jkobak@passy-muir.com (949) 833-8255 David A. Muir 23 year-old ventilator dependent quadriplegic

More information

Many thanks to my sponsor:

Many thanks to my sponsor: Oral Care for the Medically Complex Patient: From Intensive Care to Long-term Care Michigan Dental Association Lansing MI April 25, 2015 Cindy Kleiman RDH, BS Oral Care Consultant and Speaker Many thanks

More information

CUESTA COLLEGE REGISTERED NURSING PROGRAM CRITICAL ELEMENTS

CUESTA COLLEGE REGISTERED NURSING PROGRAM CRITICAL ELEMENTS CUESTA COLLEGE REGISTERED NURSING PROGRAM CRITICAL ELEMENTS LEVELS I through IV A. OVERRIDING CRITICAL ELEMENTS Violation of an overriding area will result in termination and failure of the particular

More information

SECTION 12.1 URINARY CATHETERS

SECTION 12.1 URINARY CATHETERS SECTION 12.1 URINARY CATHETERS Introduction Summary of Recommendations taken from Guidelines for the Prevention of Catheter-associated Urinary Tract Infection, Published on behalf of SARI by HSE Health

More information

Degree of Intervention

Degree of Intervention Inglewood Care Centre Degree of Intervention Handbook for Residents and Families Index Introduction..................................................... 2 Beliefs, Values, and Wishes.........................................

More information

Chapter 1: Overview of Critical Care Nursing Test Bank

Chapter 1: Overview of Critical Care Nursing Test Bank Chapter 1: Overview of Critical Care Nursing Test Bank MULTIPLE CHOICE 1. Which of the following professional organizations best supports critical care nursing practice? a. American Association of Critical-Care

More information

Sepsis: Identification and Treatment

Sepsis: Identification and Treatment Sepsis: Identification and Treatment Daniel Z. Uslan, MD Associate Clinical Professor Division of Infectious Diseases Medical Director, UCLA Sepsis Task Force Severe Sepsis: A Significant Healthcare Challenge

More information

Troubleshooting a Patient with a Chest Drain. A Simulation Workshop

Troubleshooting a Patient with a Chest Drain. A Simulation Workshop Troubleshooting a Patient with a Chest Drain. A Simulation Workshop Outline This is a simulation session that aims to improve skills at assessing a patient with a chest drain. It is undertaken using a

More information

Clinical Instructor Orientation Competency Validation Tool

Clinical Instructor Orientation Competency Validation Tool Name: Department: Date Orientation Began: Signature of Preceptor or Evaluators/Initials Levels of Performance: Novice: Novice clinical instructors are gaining knowledge and experience in clinical and technical

More information

Ventilator-Associated Pneumonia (VAP) Best Practice Strategies for Caregivers

Ventilator-Associated Pneumonia (VAP) Best Practice Strategies for Caregivers Kimberly-Clark Health Care Ventilator-Associated Pneumonia (VAP) Best Practice Strategies for Caregivers By D. Theron Van Hooser M.Ed. RRT, FAARC Overview Pneumonia accounts for nearly 15% of all hospital

More information

CLINICAL PRIVILEGES- NURSE ANESTHETIST

CLINICAL PRIVILEGES- NURSE ANESTHETIST Name: Page 1 Initial Appointment Reappointment All new applicants must meet the following requirements as approved by the governing body effective: 8/5/2015. Applicant: Check off the Requested box for

More information

Omega-3 fatty acids improve the diagnosis-related clinical outcome. Critical Care Medicine April 2006;34(4):972-9

Omega-3 fatty acids improve the diagnosis-related clinical outcome. Critical Care Medicine April 2006;34(4):972-9 Omega-3 fatty acids improve the diagnosis-related clinical outcome 1 Critical Care Medicine April 2006;34(4):972-9 Volume 34(4), April 2006, pp 972-979 Heller, Axel R. MD, PhD; Rössler, Susann; Litz, Rainer

More information

Pain Management in the Critically ill Patient

Pain Management in the Critically ill Patient Pain Management in the Critically ill Patient Jim Ducharme MD CM, FRCP President-Elect, IFEM Clinical Professor of Medicine, McMaster University Adjunct Professor of Family Medicine, Queens University

More information

Surveillance cultures PRO. Kurt Espersen ICU 4131 Rigshospitalet Copenhagen

Surveillance cultures PRO. Kurt Espersen ICU 4131 Rigshospitalet Copenhagen Kurt Espersen ICU 4131 Rigshospitalet Copenhagen Difficult to Diagnose Systemic Candidal Infection Immunsuppression in critically ill patients Frequent manifestation of fungus in ICU Fungi were isolated

More information

Implementation of the ABCDE Bundle: Results from a Real-World, Pragmatic Study Design. Andrew Masica, MD, MSCI Chief Clinical Effectiveness Officer

Implementation of the ABCDE Bundle: Results from a Real-World, Pragmatic Study Design. Andrew Masica, MD, MSCI Chief Clinical Effectiveness Officer Implementation of the ABCDE Bundle: Results from a Real-World, Pragmatic Study Design Andrew Masica, MD, MSCI Chief Clinical Effectiveness Officer 0 Gap Between Knowledge and Delivery Translational Roadmap

More information

MRSA, Hand Hygiene and Contact Precautions

MRSA, Hand Hygiene and Contact Precautions MRSA, Hand Hygiene and Contact Precautions Wesley Medical Center Department of Education May 2007 Authors: Lois Rahal, RN, BSN, CIC Brandy Jackson, RN, BSN Hope Helferich, RNC, BSN 1 Objectives Upon completion

More information

Complication Prevention

Complication Prevention Nursing Best Practice for the Stroke Patient Complication Prevention Tara Panazzolo, MSN, RN-BC Nursing Performance Improvement Advisor Hackensack University Medical Center New Jersey State Stroke Conference

More information

I) Rotation Goals. Teaching Methods

I) Rotation Goals. Teaching Methods I) Rotation Goals UNMC Anesthesia Rotation Rotation Goals and Objectives Pulmonary/Critical Care Medicine Fellowship Program University of Nebraska Medical Center Revised: 3/2016 A) To manage patients

More information

Enables MDA Medical Teams to categorize victims in mass casualty scenarios, in order to be able to triage and treat casualties

Enables MDA Medical Teams to categorize victims in mass casualty scenarios, in order to be able to triage and treat casualties MDA Disposable ALS + BLS Medical Ambulance Equipment Prices shown in CDN. Funds Items Description Picture Mass Casualty ID tag 1000 units = $350 Enables MDA Medical Teams to categorize victims in mass

More information

Licensed Vocational Nurse Scope of Practice Standards Health Care Services

Licensed Vocational Nurse Scope of Practice Standards Health Care Services 1BCHAPTER 5 2BLicensed Vocational Nurse Scope of Practice Standards I. POLICY: Licensed Vocational Nurses (LVNs) are NOT independent practitioners. It is not within the scope of LVN practice to function

More information

Fire Risk Assessment Tool: Instructions for Use

Fire Risk Assessment Tool: Instructions for Use Fire Risk Assessment Tool: Instructions for Use Purpose of the Fire Risk Assessment Tool: To assist the perioperative team in determining and communicating the potential fire risk for each individual patient.

More information

Saint Thomas Hospital Protocol. Protocol Title: Terminal Weaning from Ventilator Protocol No.: V-09. Medical Staff departments

Saint Thomas Hospital Protocol. Protocol Title: Terminal Weaning from Ventilator Protocol No.: V-09. Medical Staff departments Saint Thomas Hospital Protocol Protocol No.: V-09 Operating Unit(s) Medical Staff departments Important s: Affected: affected:! Hospital! Medicine of Origin: 2/00 " Regional Network! Surgery Reviewed:

More information

Long Term Acute Care Hospital: Criteria for Admission

Long Term Acute Care Hospital: Criteria for Admission Easy Choice Health Plan, Inc. Harmony Health Plan of Illinois, Inc. M issouri Care, Inc. Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona, Inc. WellCare Health Insurance of Illinois,

More information

By Mary Lou Sole, PhD, RN, CCNS, CNL, FAAN, FCCM, and Amy Marinski, MSN, RN, CCRN, CNL

By Mary Lou Sole, PhD, RN, CCNS, CNL, FAAN, FCCM, and Amy Marinski, MSN, RN, CCRN, CNL American Nurse Today August 2014 Vol. 9 No. 8 Ventilator-associated events: A new outcome measure By Mary Lou Sole, PhD, RN, CCNS, CNL, FAAN, FCCM, and Amy Marinski, MSN, RN, CCRN, CNL Continuing Nursing

More information

THYMECTOMY. Thymectomy. Common questions patients ask about thymectomies. www.myasthenia.org

THYMECTOMY. Thymectomy. Common questions patients ask about thymectomies. www.myasthenia.org THYMECTOMY Thymectomy Common questions patients ask about thymectomies. www.myasthenia.org The following are some of the most common questions asked when a thymectomy is being considered for adult and

More information

College of Applied Medical Sciences\ Department of Nursing

College of Applied Medical Sciences\ Department of Nursing 2 nd Edition 2014/2015 College of Applied Medical Sciences\ Department of Nursing CAMS/ Department of Nursing/ Internship Training Logbook 2 nd Edition 1 INTERNSHIP TRAINING LOGBOOK Nurse Intern Name:

More information

Community-Acquired, Health Care Associated, and Ventilator- Associated Pneumonia Three Variations of a Serious Disease

Community-Acquired, Health Care Associated, and Ventilator- Associated Pneumonia Three Variations of a Serious Disease Community-Acquired, Health Care Associated, and Ventilator- Associated Pneumonia Three Variations of a Serious Disease Susan S. Scott, MSN, RN, CCRN a, *, Cynthia B. Kardos, BSN, RN, BA b KEYWORDS Pneumonia

More information

Airway Pressure Release Ventilation (APRV) for the Treatment of Severe Life-Threatening ARDS in a Morbidly Obese Patient

Airway Pressure Release Ventilation (APRV) for the Treatment of Severe Life-Threatening ARDS in a Morbidly Obese Patient Review Crit Care & Shock (2008) 11 : 132-136 Airway Pressure Release Ventilation (APRV) for the Treatment of Severe Life-Threatening ARDS in a Morbidly Obese Patient Amyn Hirani, Rodrigo Cavallazzi, Anastasia

More information

X-Plain Preparing For Surgery Reference Summary

X-Plain Preparing For Surgery Reference Summary X-Plain Preparing For Surgery Reference Summary Introduction More than 25 million surgical procedures are performed each year in the US. This reference summary will help you prepare for surgery. By understanding

More information

Objective of This Lecture

Objective of This Lecture Component 2: The Culture of Health Care Unit 3: Health Care Settings The Places Where Care Is Delivered Lecture 5 This material was developed by Oregon Health & Science University, funded by the Department

More information

PARAMEDIC TRAINING CLINICAL OBJECTIVES

PARAMEDIC TRAINING CLINICAL OBJECTIVES Page 1 of 21 GENERAL PATIENT UNIT When assigned to the General Patient unit paramedic student should gain knowledge and experience in the following: 1. Appropriate communication with patients and members

More information

Errors in the Operating Room. Patrick E. Voight RN BSN MSA CNOR President Association of perioperative Registered Nurses (AORN)

Errors in the Operating Room. Patrick E. Voight RN BSN MSA CNOR President Association of perioperative Registered Nurses (AORN) Errors in the Operating Room Patrick E. Voight RN BSN MSA CNOR President Association of perioperative Registered Nurses (AORN) What What We All We Strive All Strive For: For: Patient Patient Safety Safety

More information

NORTH WALES CRITICAL CARE NETWORK

NORTH WALES CRITICAL CARE NETWORK NORTH WALES CRITICAL CARE NETWORK LEVELS OF CRITICAL CARE FOR ADULT PATIENTS Throughout the work of the North Wales Critical Care Network reference to Levels of Care for the critically ill are frequently

More information

MECHINICAL VENTILATION S. Kache, MD

MECHINICAL VENTILATION S. Kache, MD MECHINICAL VENTILATION S. Kache, MD Spontaneous respiration vs. Mechanical ventilation Natural spontaneous ventilation occurs when the respiratory muscles, diaphragm and intercostal muscles pull on the

More information

Secrets of the Pediatric Intubated Patient:

Secrets of the Pediatric Intubated Patient: Secrets of the Pediatric Intubated Patient: Evidence-Based Keys to Success Leslie Grant, RN, BSN, CFRN, CCRN Matt Payne, RN, CFRN, FP-C Ranked #1 in Virginia by U.S. News & World Report VCU Total Artificial

More information

Patient Care Technician (Bridge Program)

Patient Care Technician (Bridge Program) Patient Care Technician (Bridge Program) Introduction: At Prestige Medical Solutions we are fully vested in helping students succeed. Our vision is to be a great place to learn, where people are inspired

More information

BUNDLES IN 2013: SURVIVING SEPSIS CAMPAIGN

BUNDLES IN 2013: SURVIVING SEPSIS CAMPAIGN BUNDLES IN 2013: SURVIVING SEPSIS CAMPAIGN R. Phillip Dellinger MD, MSc, MCCM Professor of Medicine Cooper Medical School of Rowan University Professor of Medicine University Medicine and Dentistry of

More information

Sutter Health: Sacramento-Sierra REGIONAL ICU DELIRIUM PROTOCOL

Sutter Health: Sacramento-Sierra REGIONAL ICU DELIRIUM PROTOCOL Sutter Health: Sacramento-Sierra REGIONAL ICU DELIRIUM PROTOCOL Delirium-(acute brain dysfunction) is defined as a disturbance of consciousness with inattention accompanied by a change in cognition or

More information

Questioning common nursing practices: What does the. To improve patient outcomes, nurses need to challenge practice traditions.

Questioning common nursing practices: What does the. To improve patient outcomes, nurses need to challenge practice traditions. Questioning common nursing practices: What does the evidence show? To improve patient outcomes, nurses need to challenge practice traditions. By Mary Beth Flynn Makic, PhD, RN, CNS, CCNS, FAAN; Carol A.

More information

Common Ventilator Management Issues

Common Ventilator Management Issues Common Ventilator Management Issues William Janssen, M.D. Assistant Professor of Medicine National Jewish Health University of Colorado Denver Health Sciences Center You have just admitted a 28 year-old

More information

Bachelor s degree in Nursing

Bachelor s degree in Nursing Tbilisi State Medical University Faculty of Physical Medicine and Rehabilitation The first level of academic higher education Bachelor s degree in Nursing Tbilisi 2012 Name of program Nursing Name of qualification

More information

SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY

SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY PS1006 SARASOTA MEMORIAL HOSPITAL NURSING DEPARTMENT POLICY TITLE: NEONATAL INTENSIVE CARE UNIT: ADMISSION AND TRANSFER PROCEDURE AND ACUITY GUIDELINES Job Title of Reviewer: EFFECTIVE DATE: REVISED DATE:

More information

C-Difficile Infection Control and Prevention Strategies

C-Difficile Infection Control and Prevention Strategies C-Difficile Infection Control and Prevention Strategies Adrienne Mims, MD MPH VP, Chief Medical Officer Adrienne.Mims@AlliantQuality.org 1/18/2016 1 Disclosure This educational activity does not have commercial

More information

RN CONSULTATION. KEY TERMS: Assessment Basic tasks Consultation Home health services PRN Written parameters OBJECTIVES:

RN CONSULTATION. KEY TERMS: Assessment Basic tasks Consultation Home health services PRN Written parameters OBJECTIVES: RN CONSULTATION The purpose of this section is to assist the learner in understanding the role of a registered nurse (RN) consultant and when to seek RN consultation. KEY TERMS: Assessment Basic tasks

More information

Nursing. Management of Spinal Trauma. Content. Objectives. Objectives

Nursing. Management of Spinal Trauma. Content. Objectives. Objectives 7 cervical vertebrae Content 12 thoracic vertebrae Nursing 5 sacral vertebrae Management of Spinal Trauma Kwai Fung Betty Siu Ward Manager O&T Dept TKOH Date : 22nd April 2007 5 lumbar vertebrae 4 coccygeal

More information

Position Classification Standard for Respiratory Therapist, GS-0651

Position Classification Standard for Respiratory Therapist, GS-0651 Position Classification Standard for Respiratory Therapist, GS-0651 Table of Contents SERIES DEFINITION... 2 EXCLUSIONS... 2 AUTHORIZED TITLES... 3 OCCUPATIONAL INFORMATION... 3 GRADING OF POSITIONS...

More information

Pressure Ulcers in the ICU Incidence, Risk Factors & Prevention

Pressure Ulcers in the ICU Incidence, Risk Factors & Prevention Congress of the Critical Care Society of South Africa Sun City, 10-12 July 2015 Pressure Ulcers in the ICU Incidence, Risk Factors & Prevention Stijn BLOT Dept. of Internal Medicine Faculty of Medicine

More information

RES Non-Invasive Positive Pressure Ventilation Guideline Page 1 of 9

RES Non-Invasive Positive Pressure Ventilation Guideline Page 1 of 9 Page 1 of 9 Scope: Respiratory Care Department, Physicians, Advanced Nurse Practitioners (APRN), Physician Assistants (PA) Population: Patients receiving rescue or non-rescue non-invasive positive pressure

More information

POSTEXTUBATION STRIDOR IN ADULT ICU PATIENTS

POSTEXTUBATION STRIDOR IN ADULT ICU PATIENTS DISCLAIMER: These guidelines were prepared by the Department of Surgical Education, Orlando Regional Medical Center. They are intended to serve as a general statement regarding appropriate patient care

More information

TRANSPORT OF CRITICALLY ILL PATIENTS

TRANSPORT OF CRITICALLY ILL PATIENTS TRANSPORT OF CRITICALLY ILL PATIENTS Introduction Inter-hospital and intra-hospital transport of critically ill patients places the patient at risk of adverse events and increased morbidity and mortality.

More information

Forced vital capacity: maximal volume of air exhaled with maximally forced effort from a maximal inspiration.

Forced vital capacity: maximal volume of air exhaled with maximally forced effort from a maximal inspiration. SOP Spirometry 1. General considerations Spirometry serves as a physiological test to quantify pulmonary disease severity and to assess clinical change in respiratory function over time. Standard spirometric

More information

Ventilator Application of the Passy-Muir Valve David A. Muir Course Outline Benefits Review of the Biased Closed Position No Leak Passy-Muir Valves

Ventilator Application of the Passy-Muir Valve David A. Muir Course Outline Benefits Review of the Biased Closed Position No Leak Passy-Muir Valves Ventilator Application of the Passy-Muir Valve Michael S. Harrell, B.S., RRT Director of Clinical Education-Respiratory mharell@passy-muir.com (949) 833-8255 David A. Muir 23 year-old ventilator dependent

More information

Health-Care Associated Infection Rates among Adult Patients in Bahrain Military Hospital: A Cross Sectional Survey

Health-Care Associated Infection Rates among Adult Patients in Bahrain Military Hospital: A Cross Sectional Survey Bahrain Medical Bulletin, Vol. 32, No. 1, March 2010 Health-Care Associated Infection Rates among Adult Patients in Bahrain Military Hospital: A Cross Sectional Survey Kelechi Austin Ofurum, M.Sc, B.Sc*,

More information